How Do You Qualify For Workers’ Compensation?
Almost all job injury victims qualify for workers’ compensation, thanks to the grand bargain between workers and management. Workers agreed to forego cumbersome and expensive lawsuits if management paid no-fault benefits to injured workers. “No fault” means that even if the worker’s negligence caused the injury, full benefits are available. More on these benefits below.
Injured workers are entitled to this compensation by law. But insurance companies do not simply give this money away. Indeed, the system is dominated by insurance company interests. So, Claims Examiners deny most initial claims. A Tampa workers’ compensation attorney levels the playing field. The statistics support this conclusion. Usually, workers who have attorneys receive much larger settlements than victims without advocates.
Lost Wage Replacement
Most Florida families live from paycheck to paycheck. Furthermore, in most cases, an injured worker is a family’s primary or only income producer. As a result, even a few weeks without a check is financially crippling in most cases. The wage replacement benefit eases the financial pressure, so victims can simply focus on getting better. The amount of lost wage replacement usually depends on the nature and extent of the disability, as follows:
- Temporary Total Disability: Most trauma injury victims have TTD injuries. Usually, workers recovering from falls and other such injuries cannot work until doctors clear them. So, workers’ compensation usually pays two-thirds of the victim’s Average Weekly Wage for the duration of this temporary disability.
- Temporary Partial Disability: Some victims “graduate” from the TTD category to the TPD category. These victims can work on a limited basis while they recover. Since they must usually reduce their hours or accept lower-paying light duty assignments, workers’ compensation usually pays two-thirds of the difference between the old and new AWWs.
- Permanent Partial Disability: Many occupational disease victims have PPD injuries. For example, many repetitive stress injuries never entirely heal. Generally, these victims receive payments based on their AWW as well as the nature and extent of their disabilities.
- Permanent Total Disability: The D-word is not just a medical term. “Disability” basically means inability to work. So, this word also has educational, economic, and other implications. If a trauma injury or occupational disease permanently disables a victim, compensation is usually based on the AWW.
The Average Weekly Wage includes regular cash compensation and irregular, non-cash compensation, such as tuition reimbursement. Furthermore, the AWW is not just backwards looking. It is also forward looking. This calculation must account for things like lost future overtime opportunities and missed performance bonuses.
Medical Bill Payment
Workers’ compensation would be incomplete if victims had to pay medical bills out of their own pockets. So, benefits usually include payment of all reasonably necessary medical expenses, such as:
- Emergency care,
- Follow up treatment,
- Transportation costs,
- Medical devices,
- Prescription drugs, and
- Physical or occupational therapy.
Physical therapy rebuilds muscles that have atrophied because of injury-related non-use. Occupational therapy helps individuals acquire new employment skills to replace the ones they lost because of injury.
Insurance companies often use the “reasonably necessary” requirement as an excuse to delay payment. If that happens, a Tampa workers’ compensation lawyer normally sends a letter of protection to the affected provider. Since this letter guarantees payment when the case is resolved, the provider defers billing, so victims keep getting the treatment they need.
Contact a Diligent Hillsborough County Attorney
Injured workers are usually entitled to substantial compensation. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We do not charge upfront legal fees in these matters.